GP attitudes to managing drug‐ and alcohol‐dependent patients: a reluctant role

Abstract

The aim of this study was to determine the experience, confidence and views of GPs in South West Sydney towards managing drug and alcohol dependence and their interest in participating in shared care methadone prescribing. Five hundred and forty‐eight GPs were mailed a self complete questionnaire. Non‐responders were followed‐up by telephone. Seventy‐six per cent of GPs responded; 52% considered methadone maintenance to be effective. GPs were more confident managing smoking than alcohol and benzodiazepine dependence and least confident in illicit drug dependence. Fifty per cent reported having no patients on methadone and 40% between one and five patients. GPs in Fairfield and Liverpool reported having most patients; 25% were interested in prescribing methadone for patients in their own practice and 17% for patients referred to them. GPs who had more patients on methadone in their practice (especially those in Fairfield and Liverpool) considered methadone effective and were more likely to be interested in having patients referred to them. The most frequent reasons for not being interested were concerns about patients being demanding or aggressive or the impact on their practice. The most frequently requested support for shared care prescribing was for 24‐hour back‐up from specialist services, especially requested by those with less experience with patients on methadone. A shared‐care approach to facilitating greater GP involvement in prescribing appears feasible, especially among GPs with some previous experience with patients on methadone.

Mailed treatment to augment primary care for alcohol disorders: A randomised controlled trial

“…Figure 1 displays a CONSORT diagram on retention. Retention to 3 months (78%) compared well with retention to 2-4 months in our previous trials (55% [11], 49% [10]). However, only 96 (47% of eligible participants) were assessed at 12 months, with most dropouts in the first 6 months.…”

“…At 6 months, these proportions were 80% for both participants and GPs. When asked to rate how helpful the program was (1)(2)(3)(4)(5)(6)(7)(8)(9)(10), the means at 3 and 6 months were 6.5 and 6.6 for participants, and 6.6 and 6.3 for GP, indicating moderate perceived helpfulness on average.…”

Health professionals’ attitudes towards AOD-related work: Moving the traditional focus from education and training to organizational culture

“…For example, Abouyanni et al (2000) found that 14% of the GPs who gave reasons for not prescribing methadone believed methadone maintenance to be ineffective. Landy et al (2005) found that 54% of fourth-year medical students in Britain perceived AOD treatment interventions to lack credible evidence.…”

“…The diversity of views studied, however, makes it difficult to identify specific views and perceptions that should be targeted in education and training programs or other interventions. Common stereotypes include illicit drug users as difficult, aggressive, demanding, manipulative, deceitful, difficult to communicate with, unmotivated, time-consuming, unpredictable, entrenched and unwilling to change (Abouyanni et al, 2000;Chappel & Schnoll, 1977;Deehan et al, 1997;Greenwood, 1992;Howard & Chung, 2000a;McKeganey, 1988;McLaughlin & Long, 1996;Mistral & Velleman, 2001;Roche, Watt, & Fischer, 2001;Vader & Aufseesser, 1993). There is evidence that negative and punitive attitudes towards these individuals are relatively common among health professionals such as nurses and GPs (Aalto, Pekuri, & Seppa, 2001;Abed & Neira-Munoz, 1990;Gerlach & Caplehorn, 1999;Melby, Boore, & Murray, 1992;Norman, 2001b).…”

Developing primary care services for high-dose benzodiazepine-dependent patients: A consultation survey

“…Negative attitudes among GPs were attributed (by the GPs) to patient-behaviour difficulties such as perceived aggression, missing appointments and chaotic behaviour (McKeown et al, 2003). Some GPs cite patient-safety concerns as a reason for not being prepared to prescribe for drug-dependent clients/patients (Abouyanni et al, 2000). Conversely, drug-dependent users themselves often have negative perceptions of GP care, reinforced by difficult experiences of visits to their GP during crises (Hindler et al, 1996).…”